Diabetes in pregnancy: are we providing the best care ... - HQIP

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5. A description of women and babies in the enquiry 5.1 Introduction This chapter describes the 442 women and 442 offspring in the enquiry module of the CEMACH Diabetes Programme, after excluding the additional 79 pregnant women with type 2 diabetes sampled for the purpose of carrying out a comparison between type 1 and type 2 diabetes (see Chapters 4 and 11). Multiple births were excluded before sampling from the 3808 pregnancies in the descriptive study (see Chapter 4 for details of sampling methods). All babies who died from 20 weeks gestation up to 28 days after delivery, and all fetal congenital anomalies, were sampled for enquiry, together with a random sample of controls (singleton babies without a congenital anomaly surviving to day 28) so that there was one control for each case sampled. Women with poor pregnancy outcomes therefore represented a higher proportion of the enquiry sample than of the 3808 pregnancies in the descriptive study (approximately 50% of pregnancies in the enquiry module versus less than 10% of all pregnancies in the descriptive study). 1 5.2 The women 5.2.1 Socio-demographic characteristics The women in the enquiry were very similar to the whole population sampled from with respect to sociodemographic characteristics (table 5.1). Slightly more women in the enquiry were in the more deprived quintiles compared to women in the descriptive study. 5.2.2 Diabetes complications Twelve percent of 359 women in the enquiry had nephropathy (panel guidance was that this could be incipient with microalbuminuria or established with persistent dipstick positive proteinuria and/or serum creatinine greater than 130mmol/l). Thirty two percent of 316 women had retinopathy (pre-existing or diagnosed for the fi rst time in pregnancy) (table 5.2). Fifty one percent of 400 women in the enquiry had recurrent hypoglycaemia during pregnancy and 20% of 311 women had at least one severe hypoglycaemic episode requiring external help. Information on specifi c diabetes complications was not collected for the descriptive study of 3808 pregnancies so direct comparisons cannot be made. Chapter 6 presents the proportions of women with poor pregnancy outcome and good pregnancy outcome who had diabetes complications. 18
Table 5.1 Characteristics of women (all fi gures are % unless otherwise stated) Socio-demographic characteristics Women in the enquiry n (%) (N=442) Women in the CEMACH descriptive study 1 n (%) (N=3808) Type of diabetes Type 1 324 (73) 2767 (73) Type 2 118 (27) 1041 (27) Median age at delivery (years) [IQR] 31 [25, 34] 31 [27, 35] Ethnicity: White 354 (80) 3059 (80) Black African 16 (4) 121 (3) Black Caribbean 9 (2) 84 (2) Black Other 0 (0) 14 (0.4) Indian 15 (3) 110 (3) Pakistani 24 (5) 203 (5) Bangladeshi 8 (2) 86 (2) Chinese 1 (0.2) 7 (0.2) Other 13 (3) 116 (3) Not known 2 (0.5) 8 (0.2) Primigravidas 192 (43) 1507 (40) Median age at onset of diabetes 19 [10, 26] 20 [11, 28] (years) [IQR] Median duration of diabetes (years) 9 [4, 17] 9 [4, 17] [IQR] Deprivation quintile: 1 59 (14) 496 (14) 2 60 (15) 581 (17) 3 72 (18) 638 (18) 4 89 (22) 728 (21) 5 128 (31) 1002 (29) Missing or resident in Wales or Northern Ireland 34 363 19
Page 1 and 2: Confidential Enquiry into Maternal
Page 3 and 4: Contents Acknowledgements .........
Page 5 and 6: • Members of the CEMACH Diabetes
Page 7 and 8: Erb’s palsy Injury to the nerve r
Page 9 and 10: Neonatal unit A unit which provides
Page 11 and 12: Foreword This third and fi nal repo
Page 13 and 14: 1. Introduction This is the fi nal
Page 15 and 16: 2. Key fi ndings of the CEMACH Diab
Page 17 and 18: Suboptimal fetal surveillance of ba
Page 19 and 20: 3. Summary of recommendations This
Page 21 and 22: 2. Patient pathways of care includi
Page 23 and 24: the pregnancies meeting this defi n
Page 25 and 26: in order to remove any identifi abl
Page 27 and 28: When deriving odds ratios for any p
Page 29: Associations are reported in Chapte
Page 33 and 34: Table 5.4 Characteristics of women
Page 35 and 36: was no information available to pan
Page 37 and 38: 6. Factors associated with poor pre
Page 39 and 40: Table 6.2 Association of clinical c
Page 41 and 42: Table 6.5 Association of specifi c
Page 43 and 44: Table 6.8 Association of postnatal
Page 45 and 46: folic acid before pregnancy (19% of
Page 47 and 48: Table 7.2 Panel comments on social
Page 49 and 50: 7.5 Conclusions One of the key fi n
Page 51 and 52: 11.Dex S, Heather J (eds). Millenni
Page 53 and 54: 8. Clinical care issues: preconcept
Page 55 and 56: chance of induction of labour was r
Page 57 and 58: 8.6.1 Enquiry fi ndings Just over h
Page 59 and 60: Some quotes from the panel discussi
Page 61 and 62: Apart from the explanation of pregn
Page 63 and 64: was associated with poor pregnancy
Page 65 and 66: of women after the fi rst trimester
Page 67 and 68: 9.5.1 Panel comments on suboptimal
Page 69 and 70: During labour and delivery, the maj
Page 71 and 72: Just 52% of 383 women (38% of 164 c
Page 73 and 74: • ‘No serial growth scans perfo
Page 75 and 76: The panel enquiries, which are in e
Page 77 and 78: 10.3.1 Enquiry fi ndings Seventy fi
Page 79 and 80: 10.6 Communication Effective commun
Page 81 and 82:
Some quotes from the panel discussi
Page 83 and 84:
working between primary and seconda
Page 85 and 86:
we therefore selected 7.2% of pregn
Page 87 and 88:
11.4 Preconception behaviour The CE
Page 89 and 90:
enquiry related to a 12 month prior
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Table 11.10 Differences in postnata
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Type 1 and type 2 diabetes have tra
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Panels were chaired by the panel ch
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In 57% (24/42) of cases, a junior d
Page 99 and 100:
Infant formula given as fi rst feed
Page 101 and 102:
2.1 hours in babies remaining with
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12.7.1 Panel comments on suboptimal
Page 105 and 106:
The concerns described here probabl
Page 107 and 108:
External commentary Patricia Hamilt
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informed and motivated to manage th
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100 Appendix A: Pre-pregnancy care
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102 Appendix B: Diabetes enquiry pr
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Appendix C Association between demo
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Appendix C Association of preconcep
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Appendix C Association of postnatal
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Appendix D Association of social an
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Appendix D Association of diabetes
Page 142 and 143:
Appendix E Association between demo
Page 144 and 145:
Appendix E Association between prec
Page 146 and 147:
Appendix E Association between post
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Appendix F - CEMACH advisory groups
Page 150:
Appendix F - CEMACH advisory groups
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Diabetes in pregnancy: are we providing the best care ... - HQIP

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